Postpartum depression impacts the lives of around 20% of women, manifesting symptoms like mood swings, frequent crying, irritability, fatigue, guilt, anxiety, and difficulty caring for oneself or the baby. While it's a serious mental health condition impacting the daily lives of both the new mother and the child, postpartum depression is highly treatable.
The current treatment typically involves psychotherapy or the use of antidepressants. The researchers of a recent study who investigated an alternative treatment strategy found that a single low-dose injection of esketamine given just after childbirth could reduce the risk of postpartum depression in new mothers who experienced prenatal depression.
Esketamine was derived from ketamine, an anesthetic often used in treating depression. Recently, esketamine, a more potent form of ketamine received FDA approval as a nasal spray specifically for individuals with treatment-resistant depression.
The study involved 364 pregnant individuals above the age of 18 who were admitted to hospital for delivery. The participants had at least mild prenatal depression as indicated by the Edinburgh postnatal depression scale. They were randomly divided in a 1:1 ratio to receive either 0.2 mg/kg of esketamine or a placebo through intravenous infusion lasting 40 minutes immediately after childbirth following umbilical cord clamping.
The researchers interviewed the participants at various intervals: 18 to 30 hours after childbirth, on day 7 after giving birth, and again on day 42.
The results showed that for those with prenatal depressive symptoms, administering a single low dose of esketamine right after childbirth reduced the risk of major depressive episodes at 42 days by approximately 75%.
The participants who received esketamine also experienced reduced postnatal depression as per the Edinburgh postnatal depression scale score on day seven and as per the Hamilton depression rating scale scores at 42 days postpartum.
"For mothers with prenatal depression, a single low dose of esketamine after childbirth decreases major depressive episodes at 42 days postpartum by about three quarters. Neuropsychiatric symptoms were more frequent but transient and did not require drug intervention," the researchers wrote in the study published in the BMJ journal.
Although generally considered safe and well tolerated, esketamine needs to be administered after weighing the benefits and risks. Increased blood pressure, nausea, dizziness, vertigo, headache, and sedation are some of the known side effects.
"Side effects of low-dose esketamine depend on the rate it is administered. For example, at most, 98% of participants developed neurological or mental symptoms when 0.25 mg/kg esketamine was injected intravenously over one minute; the proportion was lower when low-dose esketamine was infused over 40 minutes. Our results are consistent with previous reports, which indicate that a single low dose of esketamine (0.2-0.25 mg/kg) infused over 40 minutes is generally well tolerated in people with treatment-resistant depression," the researchers wrote.
